<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.09.64.06" title_num="10" subtitle_num="09" chapter_num="64" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>The provider shall submit the request for payment of services rendered according to procedures established by the Program and in the form designated by the Program.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The Program reserves the right to return to the provider, before payment, all claims not properly signed, completed, and accompanied by properly completed forms required by the Program.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Unless the service is free to the general public, the provider shall charge the Program the provider’s customary charge to the general public for similar services.</text>
  </paragraph>
  <paragraph num="D.">
    <text>If the service is free to individuals not covered by Medicaid:</text>
    <paragraph num="(1)">
      <text>The provider:</text>
      <paragraph num="(a)">
        <text>May charge the Program; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Shall be reimbursed in accordance with §G of this regulation; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The provider’s reimbursement is not limited to the provider’s customary charge.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The Program will pay for covered services, the lesser of:</text>
    <paragraph num="(1)">
      <text>The provider’s customary charge to the general public unless the service is free to individuals not covered by Medicaid; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Program’s fee schedule.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>The provider may not bill the Program or the participant for:</text>
    <paragraph num="(1)">
      <text>Completion of forms and reports;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Broken or missed appointments;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Professional services rendered by mail;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Professional services rendered via telehealth when services are indicated as an exclusion; or</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Providing a copy of a participant’s medical record when requested by another provider on behalf of the participant.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Reimbursement.</text>
    <paragraph num="(1)">
      <text>Providers may bill one 60-minute or 70-minute code per month, and two additional 30-minute codes per month, unless otherwise excepted in §G(2)or (3) of this regulation.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>FQHCs may bill once per month, using a separate FQHC code.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If the primary care team determines that the participant’s condition requires more or less frequent visits than described above, the care manager may order an alternate schedule.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The Maryland Medical Assistance Program's procedures for payment are contained in COMAR 10.09.02.07D.</text>
    </paragraph>
  </paragraph>
</regulation>